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284-5743 TTY/MRS: (651) 297-4198 E-mail: DLI.BusinessLicense state.mn.us www.dli.mn.gov/ccld.asp Reset Certificate of Insurance Covering General Liability and Property Damage PRINT IN INK or TYPE your responses. Unreadable or illegible certificates will be denied. Form must be completed by the insurance agent or insurance company, not by the business/contractor. LICENSE TYPE Liability Insurance Coverage: This is to certify that the insurance policy listed below has been issued to the named.

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